CLASSIFICATIONS
PYOGENIC
Gram Positive
Gram Negative
Anaerobic
(Polymicrobial)
AMEBIC
CANDIDA
TB (rare)
EPIDEMIOLOGY
Pyogenic Abscesses
o
o
o
Bacterial
Most common
M > F 3:1
Entamoeba
M > F 7:1
40-50 million amoeba infections/year
worldwide
o Age Extremes
o Endemic Areas most susceptible
o
o
RISK FACTORS
PYOGENIC
DM
Cancer
Liver Transplant
ENTAMOEBA
Pregnancy
Steroids
Cancer
Endemic area travel (short
or long term)
EtOH?
PATHOPHYS.
PYOGENIC:
o
Peritonitis
To liver via portal circulation
Direct Spread
o
Hematogenous Seeding
o
Biliary infections
Blood supply
PATHOPHYS.
ENTAMOEBA:
o
Heart
Brain
Lungs
CLINICAL MANIFESTATIONS
o
SYMPTOMS
o
o
o
o
Fever (90%)
RUQ pain (50-75%)
Constitutional Sx
Diarrhea (<30%)
SIGNS
o
o
o
o
Hepatomegaly (50%)
RUQ tenderness
Jaundice
Acute abdomen
(<7%)
WORKUP
CBC (leukocytosis)
LFTs
Blood Cultures
Bacteremia (50%)
E Histolytica Ab
Echinococcus Ab
ULTRASOUND
CT/MRI
DIAGNOSTIC PROCEDURE
***
IMAGING-GUIDED DRAINAGE***
OTHERS
TREATMENT
TO DRAIN OR NOT TO DRAIN:
TREATMENT-ABX
Pyogenic: Gram Neg + Anaerobe cov.
Unasyn
Zosyn
3rd gen Ceph (Rocephin) + Flagyl
PCN Allergy: FQ + Flagyl, Carbapenem
Summary
Think Pyogenic (usually gram
neg/anaerobe) or E.Histolytica
Broad Spectrum Abx at first
Image Image Image
Imaging-Guided Culture +/- JP Drain
Treat for 4-6 weeks